Signs Of Acute Abdominal Pain Research Articles

Unusual left colon displacement and clockwise torsion in a 10‐month‐old Arab filly: A case report

In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10‐month‐old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention.A 10‐month‐old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the filly exhibited sweating, a body temperature of 38.5°C, tachycardia (65 beats per minute) and tachypnea (25 breaths per minute). Due to the severity of the colic and the lack of response to the conservative treatments, surgical intervention was deemed necessary. An exploratory midline celiotomy was performed to evaluate the abdominal organs. During the examination, no obvious primary lesions were identified in the evaluated organs. However, a restriction in exteriorizing the left colon's length was observed. Further examination revealed an unusual clockwise torsion of the left colon that displaced in left to the right side around the mesenteric root; thereby, pelvic flexure was located in the normal anatomical position with a short length.To the best of our knowledge, this is the first reported case of clockwise torsion and an atypical displacement of the left colon in horses. The surgical correction of the displacement was successfully performed. The filly showed improvement post‐surgery and did not exhibit any complications during the recovery period.

An Outbreak of Strangles in Arabian Horses in Saudi Arabia: Epidemiology, Clinical Signs and Treatment Outcomes

This study was carried out to investigate an outbreak of strangles in horses at the Qassim Region, Central Saudi Arabia. From 29 horses included in this study, the disease was observed in 13, five of them were died: representing a morbidity rate of 44.8% and a mortality rate of 17.24%. The morbidity and mortality rates significantly (P≤0.05) differed among different age groups. In contrast, the case fatality rate was not significantly different among different ages. Gender has no significant effect on disease occurrence. Clinically, signs observed in infected horses were high fever, anorexia, soft non-productive cough, muco-purulent bilateral nasal discharge, enlargement and abscessation of submandibular lymph nodes. Metastatic infection, including abdominal abscessation, was observed in 5 of the infected cases where signs of acute abdominal pain were recorded. Streptococcus equi subspecies equi was the only organism isolated from the lesions. Significant increases in the total white blood cells and neutrophils were detected in the diseased horses compared to healthy ones. Penicillin therapy, surgical intervention of the ripened sub-mandibular abscesses, isolation of healthy horses away from infected ones and thorough disinfection of the contaminated environment were the control measures that were applied to manage this outbreak. Treatment was very effective in the typical form of the disease whereas it had no value in the bastard form. Finally, it can be concluded that strangles in horses in the Qassim Region represents a great risk due to the high case fatality rate, and therefore using a protective vaccine is essential.

Utilização da ultrassonografia transabdominal para auxilio propedêutico em equinos com síndrome cólica

O abdome agudo na espécie equina é considerado uma emergência, sendo de grandeimportância a determinação precoce da necessidade ou não da intervenção cirúrgica comomedida terapêutica. Os objetivos dessa descrição de casos foram: identificar quais os achadosultrassonográficos (US) que auxiliam na determinação do paciente clínico ou cirúrgico, qual apossibilidade de identificação da causa da cólica e expor as dificuldades de execução datécnica. Foi realizado um estudo prospectivo observacional para análise ultrassonograficatransabdominal em 16 equinos com sinais de dor abdominal aguda. Um aparelho portátil dealta resolução, acoplado a um transdutor convexo multifrequencial de 2,5 a 5,0 MHz foiutilizado. Como resultados verificou-se que o exame US transabdominal contribuiu para adeterminação da conduta a ser adotada em todos os casos. Propiciando o diagnóstico final,detectando achados sugestivos de processo obstrutivo ou descartando-o. Os achadosimportantes para tomada de decisão e que indicam processo obstrutivo foram: a identificaçãode anormalidades na topografia intestinal, alterações de motilidade e grau de distençãointestinal, principalmente em intestino delgado, alterações no conteúdo intraluminal e emalguns casos do espessamento de parede intestinal. A atitude do animal em resposta a dor,como agitação/excitação, tremores musculares e eventualmente o tipo de conteúdointraluminal são alguns fatores que podem prejudicar a análise. Concluiu-se que o exame UStransabdominal auxilia na determinação da próxima conduta a ser adotada, cirúrgica ouclínico dos animais com síndrome cólica.

Feochromocytoma bij een paard met polymorfe ventriculaire tachycardie

Een vierentwintig jaar oude merrie die zeven jaar geleden onderzocht werd voor een mitralisklepregurgitatie en milde, linkszijdige cardiomegalie, werd aangeboden voor tachycardie, uitgesproken zweten en spiertremor. Het bloedonderzoek toonde een verhoogde hematocriet, metabole acidose, hypocalcemie, hyperglycemie en een verhoogde cardiaal troponine I-concentratie aan. Elektrocardiografie toonde talrijke ventriculaire premature contracties en monomorfe ventriculaire tachycardie die gevolgd werd door polymorfe ventriculaire tachycardie met R-op-T fenomeen. Ondanks onmiddellijke behandeling met hypertoon en calciuminfuus verslechterde de klinische situatie progressief binnen de vijfenveertig minuten na aankomst. Omwille van de gereserveerde prognose werd het paard geëuthanaseerd. Pathologisch onderzoek toonde een bijniermergtumor (feochromocytoom) van de linkerbijnier aan. Alhoewel dit paard reeds zeven en één jaar vóór het begin van de klinische tekenen van feochromocytoom onderzocht werd, konden op die momenten geen indicaties voor een neoplastisch proces of klinische tekenen van een feochromocytoom worden waargenomen. Een vroege diagnose van bijniermergtumoren kan gebaseerd zijn op catecholamine gemedieerde cardiovasculaire effecten, bloedonderzoek, bloeddrukmeting, rectaal onderzoek en rectale echografie van de bijnier. Aan de hand van een retrospectieve analyse van echocardiografische beelden en metingen konden in het voorliggende geval geen predisponerende factoren gevonden worden. In dit artikel wordt het belang van het overwegen van een feochromocytoom in de differentiaaldiagnose benadrukt, voornamelijk bij oudere paarden met polymorfe ventriculaire tachycardie, zweten, spiertremoren en acute kolieksymptomen.

Intestinal Perforation in Renal Transplant Recipients: A Single Center Experience of 2123 Recipients.

Intestinal perforation remains a clinical challenge and potentially lethal complication in renal transplant recipients. Immunosuppression not only places the patient at risk for intestinal perforation but also masks classic clinical symptoms and signs of acute abdominal pain, leading to delayed diagnosis and proper treatment. The aim of our study is to present the experience of our center on the treatment of intestinal perforation in renal transplant recipients. This study reported 11 patients (0.52%) with intestinal perforation among a group of 2123 patients who received renal transplants in the Transplantation Unit at Laikon General Hospital in Athens, Greece from 1983 to August 2015. One patient died from septic shock before any surgery, and 3 patients died during the early postoperative period, resulting in a morality rate of 36.3%. All patients who died had a functioning graft. From the patients who were discharged, the mean follow-up was 16 months (range, 4-32 months). Intestinal perforation after renal transplant is a major and potentially lethal complication. Clinical presentation is usually equivocal, and the transplant surgeon should be highly suspicious when treating a renal transplant recipient with acute abdominal pain, even in cases without other predisposing factors (diverticulitis, ischemic colitis, and so forth), so that this condition could be investigated and unmasked.

Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse

A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain. Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain. Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully. HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.

A behaviour-based pain scale for horses with acute colic: Scale construction

A validated tool for assessing the severity of acute abdominal pain is needed for the effective management of colic in horses. Two behaviour-based colic pain scales were constructed by combining together mathematical and judgemental approaches. The mathematical approach identified easily-recognised pain behaviours to select as items. The judgemental approach further modified the items and weighted them based on expert-opinion. Thirty equine practitioners assessed the level of pain demonstrated in 23 film clips of clinical cases exhibiting signs of acute abdominal pain prospectively using a 10cm visual analogue scale (VAS). The practitioners also identified behaviours noted in each clip from a checklist of 23 behaviours identified from the literature. Nine behaviours had insignificant bias and moderate-to-excellent inter-observer agreement (multirater kappas: 0.5–0.95).Six experienced veterinarians then completed questionnaires in an iterative Delphi process to independently judge 15 items that best reflected severity of pain out of 42 items generated from the literature. Two behaviours were generated by the process. Subsequently, an advisory panel of three equine practitioners constructed two clinimetric-type scales based on the results of both approaches. The two resulting equine acute abdominal pain scales (EAAPS) included 12 behaviours. One weight was assigned to each behaviour in the EAAPS-1. In the EAAPS-2, gradations of weights were assigned, based on the frequency of the behaviour being demonstrated. The EAAPS scales are the first pain severity scales designed specifically for clinical use in cases of acute colic utilising the clinimetric approach to scale construction. Further studies are underway to validate the scales.

Adrenal Failure Caused by a Retroperitoneal Malignant Mesothelioma

A 62-year-old man presented with clinical signs of acute abdominal pain and adrenal insufficiency. Computerized tomographic scans revealed bilateral adrenal tumors and the left adrenal tumor was surgically resected. The patient was found to have retroperitoneal mesothelioma presenting as bilateral metastatic adrenal tumors, which were well controlled by systemic chemotherapy with CDDP and 5-FU. This case appears to be the first reported case in the literature of adrenal failure due to bilateral adrenal infiltration caused by retroperitoneal malignant mesothelioma.

Pseudomonas aeruginosasepsis in an adult horse with enteric Salmonellosis

AbstractObjective:To report a case of enteric Salmonellosis andPseudomonas aeruginosabacteremia in an adult horse.Case summary:A 7‐year‐old mare presented for signs of acute abdominal pain. Exploratory laparotomy allowed surgical correction of right dorsal displacement of the large colon with a 180° volvulus at the cecocolic ligament. Postoperatively, the mare developed fevers, leukopenia, and diarrhea.Salmonella newportwas cultured from the feces andP. aeruginosafrom 2 consecutive blood cultures. The mare responded well to intensive medical therapy.New or unique information provided:Bacteremia associated with colitis is unusual in an adult horse, although the percentage of animals that may be bacteremic is unknown. The bacteria isolated,P. aeruginosa, a common pathogen of other sites in the horse, has not, to our knowledge, been previously reported as a cause of bacteremia and septicemia in an adult horse.

Evaluation of surgical treatment for signs of acute abdominal pain in draft horses: 72 cases (1983–2002)

To determine whether heavy (> or = 680 kg [> or = 1,500 lb]) draft horses undergoing surgical treatment for acute signs of abdominal pain were at a greater risk for anesthetic and postoperative complications and lower postoperative survival rates than light (< 680 kg) draft horses. Retrospective case series. 72 draft horses. Medical records of draft horses that underwent exploratory celiotomy for signs of acute abdominal pain from October 1983 to December 2002 were reviewed. Medical records of draft horses in which a celiotomy was performed for correction of reproductive abnormalities were not included in the study. When compared with light draft horses, heavy draft horses had longer durations of anesthesia, more postoperative complications, and lower survival rates. Seventy-six percent of horses that recovered from anesthesia had postoperative complications. Postoperative complications associated with low survival rates included myopathy and neuropathy, ileus, diarrhea, and endotoxemia. All horses with postoperative myopathy and neuropathy died or were euthanized. The short-term survival rate for horses that recovered from anesthesia was 60%. Horses undergoing small intestinal surgery had a worse prognosis for short-term survival than those undergoing large intestinal surgery. The survival rate for horses for which long-term (> 1 year) follow-up information was available was 50%. Draft horses weighing > 680 kg that underwent surgery because of acute signs of abdominal pain had longer durations of anesthesia, more postoperative complications, and higher mortality rates than draft horses weighing < 680 kg.

Ultrasonography of the acute abdomen

For many years, ultrasonography has been considered to be one of the most valuable imaging techniques for evaluation of the abdominal cavity and its organs. In most cases, abdominal ultrasonography helps obtain information that leads to a definitive diagnosis. Ultrasonography is also valuable to narrow the list of differential diagnoses obtained with other diagnostic techniques. This article discusses the role of ultrasound for the diagnosis of the most common diseases that can produce clinical signs of acute abdominal pain. Abdominal organs that can be evaluated using ultrasound include the liver, biliary system, pancreas, stomach, small intestine, kidney, urinary bladder, uterus, and prostate. Pathologies of the abdominal cavity and retroperitoneal space can be also diagnosed with ultrasonography. Interventional ultrasound techniques are useful to either assist in getting the definitive diagnosis or to treat certain pathologic conditions.

Use of diagnostic ultrasonography in horses with signs of acute abdominal pain

Objective To evaluate the use of abdominal ultrasonography as a diagnostic tool in horses with signs of colic. Design Prospective study. Animals 226 horses with signs of acute abdominal pain were compared to 20 clinically normal horses. Procedure The following were performed in horses with signs of colic: physical examination, CBC, abdominal fluid analysis, placement of a nasogastric tube to obtain gastric reflux, abdominal palpation per rectum, and ultrasonography of the abdomen. Results of ultrasonography were compared with the surgical, necropsy, or medical findings. Results Ultrasonography of horses with primary small-intestine lesions revealed images of small intestine with a wall thickness of 0.2 to 1.8 cm and a diameter of 3.6 to 13.5 cm without evidence of motility. Horses with peritonitis did have evidence of small-intestine motility on ultrasonography with a wall thickness of 0.5 to 1.3 cm and a diameter of 2 to 5.1 cm. Horses with primary large-colon lesions or small-colon impactions had small-intestine diameters on ultrasonographic evaluation of 3 to 7.1 cm. In these horses, small-intestine motility was detected. If abnormal small intestine that lacked motility was detected by ultrasonographic evaluation, the sensitivity, specificity, and positive and negative predictive values for small-intestine strangulation obstructions were 100%. Detection of distended or edematous small intestine by abdominal palpation per rectum provided a sensitivity of 50%, specificity of 98%, positive predictive value of 89%, and negative predictive value of 89% for small-intestine strangulation obstructions. Clinical Implications The use of abdominal ultrasonography in horses with signs of colic is accurate for detecting small-intestine strangulation obstructions. (J Am Vet Med Assoc 1996;209:1597–1601)

THE ACUTE ABDOMEN IN THE HORSE EPIDEMIOLOGIC CONSIDERATIONS

SUMMARYA retrospective case history study of acute gastro‐intestinal disease in the horse was undertaken to determine: 1) if a statistically significant age, sex, or breed distribution existed; 2) if a correlation existed between duration of clinical signs and surgical complications; and, 3) if the lesions causing the signs significantly altered surgical prognosis. Significant age, sex and breed distributions existed. Duration of clinical signs ranged to 5 days with a definitive time trend existing for surgical correction of strangulating colics. Surgical correction was successful only within 24 hours of the appearance of clinical signs. Surgical prognosis for specific intraabdominal lesions ranged from 20% survival with strangulation obstructions to 84% with impaction.Differential diagnosis in horses with signs of acute abdominal pain is difficult, and techniques available for this purpose are limited. 3,7,8 Differentiation of specific lesions is necessary because the prognosis varies greatly with each, and the choice of treatment used depends on the nature of the lesion.1 Knowledge of significant age, sex, or breed related distributions would aid differential diagnosis. There are few epidemiologic reports available for use in the clinical management of these cases.4A recent report has dealt with the relative incidence of various types of intestinal obstructive diseases in the horse.7 The purpose of this retrospective case history study of gastrointestinal disorders in the horse was to determine:1. If a statistically significant age, sex or breed distribution existed for all or specific lesions;2. If a correlation existed between duration of clinical signs and surgical survival; and3. If the lesions causing the clinical signs significantly altered surgical prognosis.